Provider Demographics
NPI:1245371392
Name:DUNETZ, WAYNE ADAM (DPM)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ADAM
Last Name:DUNETZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:MR
Other - First Name:WAYNE
Other - Middle Name:ADAM
Other - Last Name:DUNETZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 31327
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89173-1327
Mailing Address - Country:US
Mailing Address - Phone:702-821-6763
Mailing Address - Fax:
Practice Address - Street 1:4450 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5783
Practice Address - Country:US
Practice Address - Phone:702-821-6763
Practice Address - Fax:702-684-6015
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9904213EP1101X, 213ES0103X
NVPA637363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002402377Medicaid